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OLT .ECTRICAL PERMIT A _LIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 13-0 j.) 7 _� ✓'� 5/7:7" <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: e s/� ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3�5Z.)J <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES I (NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> S�Iv�►-4- i:=l {.2,z l�;f,C Tl) b 57-s rE <br /> _/f CONTACT INFORMATION <br /> OWNER NAME: ,41 /,K �e r' h0 fC%►" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 96 -0 '7F-1 / VO! 5 l= <br /> CITY !—6/. e_f STATE "Nl4 ZIP 9 F2 ec- <br /> OWNER PHONE: 4'25 92 2^ 7//2') OWNER EMAIL: <br /> CONTRACTOR NAME: 1)��/�C y'/GG 41 t C <br /> CONTRACTOR ADDRESS: STREET <br /> CITY ZIP <br /> CONTRACTOR PHONE: 360- 770-2 /e .6.) J CONTRACTOR EMAIL: S- 6W/ �" <br /> CONTRACTOR LIC.#(REQUIRED):6(A A-1-eat g�fr CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: .OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 34 L! 7 7U'-2 1 - <br /> Jr• ct' CONTACT EMAIL: (i LA f\-461\.2. IeG-I-/'•C-C' ANS•1- rIO.AA <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> — - 1-00, <br /> l( l� � E oa- o0l <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />